Pituitary adenoma consistency is associated with postoperative hormonal deficits: a retrospective study on 50 patients undergoing transsphenoidal adenomectomy

Background: Little is known about possible predictors for hormonal function following pituitary surgery. Tumor consistency has recently emerged as a key factor in surgical planning for pituitary adenomas, influencing both the surgical outcome and the onset of postoperative complications. However, its impact on postoperative endocrine function has yet to be explored. Objectives: To evaluate the impact of tumor consistency on the development of postoperative pituitary deficits. Methods: We performed a single-center, retrospective analysis of 50 consecutive pituitary surgeries performed between June 2012 and January 2021 at Policlinico Umberto I in Rome. All patients underwent radiological and biochemical evaluations at baseline, as well as hormonal assessments 3 and 6 months after pituitary surgery. A single surgeon performed all surgical procedures and provided data regarding tumor consistency and macroscopic appearance, as well as neurosurgical approach. Results: 50 patients [24 females, mean age 57±13 years, median tumor volume 4800 mm3], were included. Greater tumor volume and male sex were both associated with worse preoperative endocrine function (P<0.0001). All patients underwent transsphenoidal adenomectomy without intraoperative complications. Fibrous adenoma consistency was observed in 10% of patients and was associated with a greater risk of developing postoperative hormone deficiencies at 3 months (X2=4.485, P=0.05, OR=8.571; 95% CI: 0.876-83.908) but showed only borderline association with endocrine deficits at the 6-months follow-up (X2=3.986, P=0.07, OR 7.733, 95% CI: 0.792-75.474). Conclusions: Predictors of endocrine outcomes following pituitary surgery are still an unmet need. In this small cohort, we demonstrated that tumor consistency might provide useful information about postoperative pituitary function, likely due to its impact on surgical procedures. Further prospective studies with larger cohorts are needed to confirm our preliminary findings.